Nursing News

Work More, Gain More? New Study Links Nurses’ Adverse Work Schedules and Obesity

August 10, 2012 - If you routinely work long hours or shift work, your health may suffer as a result. You may not get enough sleep or rest. That may cause you to lose the motivation to exercise and eat a healthy diet, which puts you at an increased risk for obesity and related health problems.

A new study published in the Journal of Environmental Medicine compared obesity-related factors between female nurses with “favorable” work schedules with nurses with “adverse” work schedules--that is, long hours, shift work, overtime and extended work shifts. The researchers found work schedules do have an impact on a nurse’s health.

That means that nurses who work those less-than-ideal shifts may have to be more proactive about avoiding the behaviors that may lead to weight gain.

“We should put our priority into better sleep and more exercise and a quality diet,” said lead author Kihye Han, PhD, RN, a post-doc fellow at the University of Maryland School of Nursing.

Exploring the causes

In a 2011 study in the Journal of Nursing Administration, Han and her colleagues described a link between “jobs with long work hours and less physical exertion” and nurse obesity. The new study noted that obesity-prevention opportunities aren’t always available to nurses who work long or adverse hours.

“Those with unfavorable work schedules also may not have ready access to healthy foods, promoting the likelihood for unhealthy eating habits,” wrote Han, et. al.

For example, the hospital cafeteria may close at night, leaving vending machines as the only sources for late-evening nourishment. Some hospitals now sponsor on-site farmers’ markets, but nurses who work in the evenings or at night may not be able to get there while they are open. Along the same lines, gyms and fitness centers may not be available to some nurses who work unfavorable work schedules.

Lack of sleep can also make nurses more vulnerable to stress and can lead to other unhealthy behaviors like smoking and moderate-to-heavy alcohol consumption, Han said.

There also is a metabolic link between lack of sleep and weight gain. According to the National Sleep Foundation, studies have shown that inadequate sleep can predispose people toward putting on extra weight. For example, a 1999 study found that participants’ metabolisms were impaired when they built up a sleep debt. Their ability to process glucose declined, and they needed to make more insulin than people who got enough sleep.

What you can do

The demands of the night shift are well known. Night-shift nurses often have trouble logging enough sleep because the rest of the world is awake when they’re trying to get some shut-eye. However, compared with a series of rotating shifts, the regular night shift at least allows nurses the chance for some consistency.

Atlanta endocrinologist Scott Isaacs, MD, recommended sticking to a consistent sleep-wake cycle. “Try to keep that schedule the same every single day,” he said.

But that’s harder for nurses who do work those rotating shifts, as they’re constantly changing the times that they’re sleeping, waking and eating.

“It’s better not to keep switching your shifts, if you can arrange it,” noted Brad Saks, PsyD, co-owner of North Shore Center for Weight Management in Chicago. “But I realize that not everyone can arrange that.”

But you can develop a schedule for each shift, which helps you plan times for meals, snacks and exercise, Saks said.

Certified diabetes educator Amy Margulies, RD, noted that hospital cafeterias don’t always serve the healthiest food. Nurses can bring their own healthy meals and snacks, regardless of the time of their shift, so they always have access to a healthy option. Good options include hummus or peanut butter and raw veggies, low-fat cheese sticks, low-fat Greek yogurt, frozen grapes or strawberries.

But if you do hit the cafeteria, be mindful of what you choose.

“A salad bar is a great option as long as they pick the right things,” said Margulies, the lead registered dietitian at Retrofit, a weight-loss company based in Skokie, Ill.

Saks also suggested writing down everything that you eat, using either a journal or a smartphone application like My Fitness Pal or Lose It. “It makes you so much more mindful and accountable and aware of what you really eat,” he said.

You should also schedule some exercise.

“Exercise needs to be a priority,” Isaacs said. “I recommend exercising before they go in for a shift…if they wait ‘til afterward, there’s a good chance it’s not going to happen.”

While nurses do need to take personal responsibility for their behavior, employers can also take steps to support them, from encouragement to staffing decisions.

“Employers should encourage their employees to exercise because employees that work out are healthier and more productive at doing their job,” said registered dietitian Lauren Schmitt, RD, owner of Healthy Eating and Training, Inc.

Mary Bylone, RN, MSM, CNML, noted that nurses are responsible for their own choices, but employers can help by doing things like offering healthy food choices.

Mary Bylone, RN, MSM, CNML, treasurer for the American Association of Critical-Care Nurses, said, “Employers shouldn’t demand that staff work schedules which leave them exhausted and unable to concentrate. But stamina varies from person to person. The length and number of shifts that’s reasonable for one person may tax someone else.”

An exhausted employee is also dangerous for patients. A 2004 Health Affairs study, “The Working Hours of Hospital Staff Nurses and Patient Safety,” found that nurses who work shifts that exceed 12 hours are more likely to make errors or “near errors.” So the authors called for curtailing the routine use of 12-hour shifts and eliminating overtime.

“Organizations that mandate overtime should take a hard look at alternatives that provide safe staffing and healthy work environments,” said Bylone.

Hospitals can also take some other simple steps to support their employees in their efforts to remain healthy, like mapping indoor and outdoor walking courses and encouraging staff to find exercise partners, Bylone said.

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